伴有下斜肌亢进的分离性垂直偏斜的手术疗效分析

Surgical effectiveness analysis of dissociated vertical deviation associated with inferior oblique overaction

目的分析下斜肌转位术对伴有下斜肌亢进的分离性垂直偏斜(dissociated vertical deviation,DVD)的矫正效果。方法回顾性分析我科行下斜肌转位术的24例(30眼)伴有下斜肌亢进的DVD患者的完整资料,并根据术前原在位垂直斜度将患者分为小度数、中等度数和大度数组,比较下斜肌转位术对各组近距离(33cm)和远距离(5m)原在位垂直斜度矫正效果。所有患者下斜肌固定于下直肌颞侧缘外的浅层巩膜,与下直肌附着点位于同一水平线上。合并水平斜视者同期手术矫正。结果近距离小度数DVD组、中等度数DVD组、大度数DVD组治愈率分别为100%、0、0;3组有效率分别为92.3%、7.7%、0;3组无效率分别为41.7%、25.0%、33.3%;远距离时各组治愈率分别为100%、0、0;3组有效率分别为92.9%、7.1%、0;3组无效率分别为25.0%、50.0%、25.0%;无论是近距离还是远距离,下斜肌转位术对小度数和中等度数DVD组的原在位垂直斜度矫正效果明显优于大度数DVD组,差异均有统计学意义(均为P<0.05),小度数和中等度数DVD组比较,差异无统计学意义(P>0.05)。结论下斜肌转位术对小度数DVD组(≤10△)和中等度数DVD组(11△～19△)近距离和远距离原在位垂直斜度的矫正效果明显优于大度数DVD组(≥20△)。

Objective To analysis the surgical effectiveness of anterior transposition of inferior oblique muscle for dissociated vertical deviation（DVD） associated with inferior oblique muscle overaction.Methods Twenty-four patients（30 eyes） underwent anterior transposition of inferior oblique muscle for DVD associated with inferior oblique muscle overaction in our department were analyzed.The patients were divided into large,medium and small degree groups based on the vertical deviation,and the surgical effectiveness of three groups in 33 cm and 5 m were compared.Patients underwent anterior transposition of inferior oblique muscles to the medial edge of inferior rectus muscle insertion,the horizontal rectus muscle was operated for horizontal strabismus at same time.Results The cured rate of large,medium and small degree group at 33 cm were 100%,0,0,the effective rate were 92.3%,7.7%,0,and the ineffective rate were 41.7%,25.0%,33.3%;The cured rate of large,medium and small degree group at 5 m were 100%,0,0,the effective rate were 92.9%,7.1%,0,and the ineffective rate were 25.0%,50.0%,25.0%.Regardless of near and far distance,the surgical effectiveness of anterior transposition of inferior oblique muscle in small and medium group were obviously better than that in large degree group,there were statistical difference（all P0.05）,but there was no difference between small and medium group（P0.05）.Conclusion The effectiveness of anterior transposition of inferior oblique muscle in small（≤10△）and medium degree（from 11△ to 19△）group are more better than that in large group（≥20△） in near and far distance.